Senior Claim Auditor – Benefits & Life Claims

Central States Health & Life Co. of Omaha; Omaha (NE); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Central States Health & Life Co. of Omaha is seeking a dedicated claims auditor to review, analyze, and authorize payment of benefits within policy guidelines.

This role involves evaluating eligibility, entering data into the claims system, and communicating with banks, agents, doctors, and claimants. The position requires strong customer service experience, solid computer skills, and excellent verbal/written communication.

Qualifications

• Associates Degree in Business or equivalent experience.
• Five years of claim auditing experience with progressive duties.
• Customer service experience requiring resolutions of issues.
• Strong computer skills with various software packages to retrieve and document information.
• Excellent verbal and written communication and attention to detail.

Responsibilities

• Review, analyze, investigate, and authorize payment of benefits within guidelines.
• Evaluate claim/benefit forms to determine eligibility and payment decisions.
• Enter claims data into the claim system and document information.
• Prepare correspondence to banks, agents, doctors, claimants and beneficiaries.
• Communicate by phone with insureds, beneficiaries, banks, doctors, and attorneys.
• Review life and medical information for eligibility and exclusions.
• Identify potential fraud and refer to Legal for determination.
• Support home office sales force and accounts with questions and status concerns.
• Follow-up on pending claims and information requests.
• Stay abreast of state requirements and industry changes.
• Assist with special projects and cross-department collaboration.
• Interact with other departments to resolve problems.

Skills

Computer skills

Verbal & written communication

Customer service

Attention to detail

Education

Associates Degree or equivalent experience

Tools

Claims system software

Job description

Central States Health & Life Co. of Omaha is seeking a dedicated claims auditor to review, analyze, and authorize payment of benefits within policy guidelines.

This role involves evaluating eligibility, entering data into the claims system, and communicating with banks, agents, doctors, and claimants. The position requires strong customer service experience, solid computer skills, and excellent verbal/written communication.